“Experience should teach us to be most on guard to protect liberty when the Government’s purposes are beneficent. Men born to freedom are naturally alert to repel invasion of their liberty by evil-minded rulers. The greatest dangers to liberty lurk in insidious encroachment by men of zeal, well-meaning but without understanding.” U.S. v. Olmstead – Justice Brandeis

Posts Tagged ‘Wrongful Conviction’

Read the Sentencing Projects’s report: Dollars and Detainees: the Growth of For Profit Detention, and you will find confirmed that when profit is introduced into public services the result is increased costs, decreased quality, and cover-up of corruption.

“The companies with which ICE and USMS contract, including CCA and the GEO Group, are largely the same ones that have been criticized for their handling of prison operations. More importantly, these companies operate off of the same business models employed in prison privatization that have led to understaffing, negligence, and abuse.107, 108, 109 In addition to harming those housed in contract facilities, private prison companies fail to save taxpayers money, can have a deleterious financial effect on communities,110 and contribute to the continuation of America’s use of mass incarceration and detention.111, 112 These private companies operate within complex and sometimes opaque systems where public and private officials cannot clearly answer questions and where the private companies managing federal detainees are not subject to Freedom of Information requests.113”

The only solution is massive reform of our justice system which today is an injustice system. Read about the Myth of American Justice as seen in Illinois at this blog and the links listed in it: http://cookcountyjudges.wordpress.com.

As a wrongfully convicted felon who was sentenced to 2 yrs in prison and 1 yr parole in 2007, I can tell you about abuse, as well as a totally dysfunctional parole system – READ THIS:

Texas executed an innocent man, Cameron Todd Willingham on February 16, 2004.. I think this is now pretty clear. This is NOT the only case of a wrongful execution. It is estimated that 7 % of people on death row are innocent. The other cases are covered up. Perry denied a stay of execution in the face of clear evidence that the alleged arson that Mr. Willingham was accused of was a fabrication of junk science. I would puke if Gov. Perry was EVER elected president. The morals of the residents of the state of Texas who vote for Gov. Perry are questionable to me.

Willingham was convicted and executed for the alleged arson that killed his three small children. Against the advice of his own counsel, Willingham also declined a life sentence in exchange for his guilty plea. He insisted he would not admit to something he had not done, even if it meant sparing his life.

A four-person panel of the Texas Forensic Science Commission investigating evidence of arson presented in the case acknowledged on July 23, 2010, that state and local arson investigators used “flawed science” in determining the blaze had been deliberately set.

The bastardized and corrupt psychiatry grinder, where the soft science of psychiatry is twisted and abused for ulterior motives, was used to fabricate a motivation for the alleged arson “murder” of his three children, when the fire was simply a terrible accident and tragedy. When will we put psychiatry hired guns like psychiatrist, James Grigson, also known as “Dr. Death” for bragging that he testifies in murder trials all over Texas to obtain convictions in murder cases, out of business?

The court, as they always do allowed the prosecution to falsely demonize the defendant – taking every little aspect of his life such as slapping his wife, having a heavy metal band poster or previous misdemeanor minor crime conviction and exaggerating it, expansively drawing a tale that Willingham was some kind of unremorseful monster. Willingham may have not been a Mother Teresa, and may have used vulgar language on occasion and even have hit his wife or had misdemeanor convictions for minor crimes, but this does not make him a monster who should be killed like a rodent.

The prosecution stretched every possible direction to paint a picture of Willingham as some kind of unremorseful creep. The prosecution claimed that Willingham may have been motivated by a desire to rid himself of his unwanted children. They extrapolated in a giant leap the fact that he had hit his wife a couple of times into a theory that he beat her up in trying to cause abortions when she was pregnant! The prosecutor also claimed that Willingham was a sociopath based on heavy metal band posters he had on his wall and other overreaching arguments.

This is how jurors are brainwashed into a wrongful conviction and it happens all the time! When will the public insist and Congress pass laws to guarantee that courts seek the truth and not just a grotesque fabricated story from the prosecutors to get another notch on their gun? When will prosecutors be held accountable for hiding the truth? When will politicians and judges be held accountable for suppressing the truth or rushing to judgment without giving time to uncover the truth? Where is the public outcry against this state sponsored murder of an innocent man?

However, those not associated with the case paint a different picture of Willingham. His former probation officer, Polly Goodin, said he had never demonstrated bizarre or sociopathic behavior and “He was probably one of my favorite kids,” she said. Even a former judge named Bebe Bridges—who had often stood, as she put it, on the “opposite side” of Willingham in the legal system, and who had sent him to jail for stealing—said that she could not imagine him killing his children. “He was polite, and he seemed to care,” she said.

For more information read here. We should never forget C. Todd Willingham. He should be the catalyst to end the death penalty in the U.S. Until we do, it will be wrongfully used as a tool for political campaigns and revenge even against the innocent.

The following is A SCHEME TO DENY MENTAL HEALTH CARE IN ILLINOIS TO PERSONS ON MEDICAID.

Illinois has essentially de facto suspended Dr. Bennett’s Constitutional right to relief from a wrongful conviction by a Habeas petition. Attorney General Lisa Madigan has committed fraud upon the court and the Cook County Circuit Court Judge Lon Schultz has violated Federal and State law, the Constitution, and all morality by convicting her on a charge of Medicaid vendor fraud.

Please read this carefully and write the Asst. U.S. Attorney General in Chicago, Patrick Fitzgerald – Office of U.S. Attorney General, 219 S. Dearborn, Fifth Floor, Chicago, Illinois, 60604; Director of the Chicago FBI, Robert Grant and the Director of the Task Force on Public Corruption, Special Agent Casanovich, Chicago FBI, 2111 S. Roosevelt Road, Chicago, Illinois 60608, as well as inform the press with letters and phone calls about this gross injustice. Help me disseminate this information far and wide around the world, until agents of the United States government intervene to stop this injustice.

HABEAS LAW VIOLATED

In March 2009 Dr. Maisha Hamilton Bennett filed a petition for writ of habeas corpus (the grand writ guaranteed by the United States Constitution) in the Illinois Court system. It found its way to the Chancery Court Division of the Cook County Circuit Court before Judge Stuart Palmer. A habeas petition is a last resort step when the court system has failed to free an innocent person or a person whose rights under the Constitution’s Bill of Rights were so violated that they were denied a fair trial.

To date Judge Palmer has refused to hear the habeas petition, recently transferred it to criminal court, where presiding criminal court Judge Biebel is also delaying hearing the petition for weeks to months. The law actually says that any judge who refuses to hear the petition “promptly” shall be referred to the States Attorney or Attorney General for prosecution of this illegal act and when found guilty should be fined $1000 and the money paid to the prisoner.

Dr. Bennett is innocent because the indictment is legally void – it didn’t adequately state the facts charged so was impermissibly vague, the Federal Medicaid Law allows the conduct that the State says is criminal – thus the Constitutional Supremacy clause was violated – state laws are invalid if they go against federal law, the trial was conducted unfairly, the alleged prosecutor, Attorney General Lisa Madigan violated the law and committed extreme prosecutorial misconduct and the court had NO jurisdiction as a result. For case law and detailed discuss of Code pertaining to Federal Medicaid Code see:

Dr. Bennett was wrongfully convicted of Medicaid vendor fraud in 2003 and is being held in jail without bond. (Now for over 18 months) She is alleged to have ghost-billed for mental health services either not done or done by non-physicians in her practice group practice – she is a Ph.D psychologist and owner of the group, Hamilton Wholistic Healthcare, and alleged to have caused bills to be sent to Medicaid under the name of the practice’s medical director, a physician, who did not see the patients.

The facts are that Hamilton Wholistic Healthcare was an Illinois Certified Alcohol and Drug Treatment Center run by Trinity Hospital and then when Trinity pulled out, run by Hamilton Wholistic Healthcare. It was an INPATIENT center. Counselors who were M.S. and Ph.D. psychologists as well as physicians when they needed medication treated the patients. The patients’ children were also evaluated and treated with counseling or the parents were counseled. The law allows a service provider to bill the insurer for providing service to the child when the parent is counseled without the child present. The AMA code book for services states this fact. Insurance companies pay these bills with no problems.

The State put a grandmother on the stand, who was caring for several grandchildren while their mother was in the inpatient drug-treatment center, and she said she was not aware the children were counseled when they visited their mother in the inpatient center. This was the “basis” for the ghost-billing charge. Under federal HIPAA laws the mental health counselors and doctors are NOT ALLOWED to inform the grandmother as she was not the legally guardian. These privacy laws forbid discussions with the grandmother without the mother’s consent. The fact that she didn’t know did not prove anything. It certainly did not prove that the children or the mother were not counseled about how to deal with the drug-addicted mother or parenting. This was NOT explained to the jury.

The defense attorney was incompetent in that he failed to put on the stand the counselors so they could introduce the fact the kids and mother were counseled. The law DOES NOT ALLOW the attorney to place into evidence the medical record – only testimony about the medical record, in criminal trials. This is because medical records are considered hearsay and cannot be cross-examined. He failed to put on the stand the children who were then old enough to testify. He failed to put on the stand the mother.

The billing agent made an error that she admitted she did because the IL Medicaid Provider Service Unit representative told her to do it. This representative told the billing agent, Louise Moore owner of Data Medical Works, that only physicians names could be on bills, so Ms. Moore forged the signature of the medical director on a power of attorney form which allows Ms. Moore to put the doctor’s name on electronic bills, on a Blue Cross/Blue Shield electronic partner trading agreement which allows BC/BS to accept the bills over the wires (computer) on behalf of Medicaid, check them for errors as a service to Medicaid, and forward them to Medicaid. She also forged signatures on an alternate payee agreement so that the checks would be written by Medicaid to Hamilton Wholistic Healthcare instead of to the physician medical director. These checks were immediately deposited in the corporate bank account and not in Dr. Bennett’s bank account. None of this was told to the jury. Dr. Bennett was even charged with this forgery, but the charges of forgery were dropped. I saw the alleged forged documents. They had signatures that appeared to be in the handwriting style of Ms. Moore and many of the alleged invoices’ provider signature presented to the crime lab in the perjury charge appeared to be cut-outs from the handwriting exemplars (handwriting samples) that Ms. Bennett was forced to provide where she was told to write the medical director’s name 30 times or so on a piece of paper. Even my teenage son, at the time, was able to match specific signatures from the handwriting exemplars to specific invoices. The crime lab rejected the invoices for analysis because the man I suspect of fabricating them by cutting out handwriting exemplars, State Police Investigator William Reibel, refused to produce originals. That is why the charges were dropped, to my understanding.

Community alcohol and drug addiction treatment centers, per Illinois Statute, separate from the Illinois Medicaid Code, are allowed to bill Medicaid under their corporate name and not a doctor’s name and to bill for services of non-physician counselors and psychologists, as long as a physician medical director sets policy – not that she sees patients.

Hamilton Wholistic Healthcare sent patient encounter forms to Ms. Moore listing the counselor’s name and not the doctor’s name, for each clinic visit when a patient was seen by the counselor in or out of the inpatient center. Without Dr. Bennett’s knowledge (she was the CEO) Ms Moore changed the name of the provider counselor on the electronic bill she generated from these patient encounter forms to the name of the doctor medical director and sent them in to Medicaid electronically. Medicaid then paid Hamilton Wholistic Healthcare. The payments went as salaries to the counselors and to overhead. A small percent went to the CEO. The total amount received from Medicaid for several years was about $400,000.

Therefore, Dr. Bennett is innocent because she was not involved in putting the medical director’s name on the electronic bills. She did not profit from this error. The federal and state laws allow physicians to bill for their employees. Ms. Moore should have used the name of the corporation and not the name of the medical director on the electronic bills. There was clearly no intent to defraud. All services were actually provided and addicts received appropriate treatment, as did their children who needed counseling to cope with this situation of an addicted parent.

There was an administrative error that WAS NOT A CRIME in that the name of a physician medical director instead of the group name was put on the bill, by order of the Medicaid Provider Service Unit representative. All services were provided; only the incorrect provider name was on the electronic invoice, at the direction of Medicaid to Ms. Moore.

As 80 % or more of mental health services are provided by non-physician psychologists, psychiatric nurse counselors, psychiatric social worker counselors, drug-addiction counselors (all licensed in Illinois) and their supervised students, it is bizarre and simply wrong for the State to claim that ONLY physicians can provide mental health services and Medicaid won’t pay for non-physician services (unless provided by a certified and licensed community mental health center.) This would prevent access to care for Medicaid patients to ALL private psychologists, counselors, etc. This is simply a fraudulent scheme to deny mental health care to persons on Medicaid to save the Illinois budget. This is also a scheme AG Lisa Madigan uses to claim she is “tough on fraud” and to take advantage of the present climate of hating physicians. These fraudulent indictments of Psychologists and psychiatrist are used as a smoke screen and scapegoat to hide the fact Illinois is violating the Federal Medicaid Code and the Constitution. I was also fraudulently indicted, but found NOT guilty because I had a good attorney. Dr. Bennett did not have a good attorney.

The Illinois Attorney General’s statement about the conviction that Dr. Bennett is a scumbag who ripped the state off for $400,000 billing for mental health services for children that never were provided is nothing but a bald faced lie. AG Lisa Madigan should be impeached for fraud upon the court and fraud upon the public.

This is penny wise and pound foolish, as failure to treat mental health patients increases, suicide, family break-up, and crime, as well as increased cost to the state for welfare, criminal justice, prison, and hospital care.

Mental Health care in Illinois to poor persons is virtually non-existent. The United States healthcare system is in meltdown and our legislators are acting like children instead of addressing the issues. I miss Senator “Teddy” Kennedy deeply! God Help Us!

I want to publicly ask the 12 jurors who wrongfully convicted me to read my appeal, find out what was withheld from them illegally; find out what lies were told by the prosecutor and what judicial misconduct was done by the judge that denied me a fair trial. Then tell me they still think I’m guilty.

I believe jurors should be held accountable and should have to read the appeal. If they then think I should have been found innocent, they should speak out about the corrupt system and how prosecutorial and judicial misconduct was used to bias them and wrongfully convict me.

The jurors names and general place of residence are as follows, which is public record, as they were stated in open court and their names are signed on the guilty verdict form. I wrote them after the trial asking them to review information that was withheld from them and to tell me if this would have changed their decision. NOT ONE had the courtesy to write me with an answer. I promised not to write them again, so I am simply putting this on the Internet and hoping their conscience bothers them enough to read it and correct their harmful mistake as the right thing to do:

William Moldenhauer Northwest Side of Chicago

Francine Prisby Arlington Heights

Joanne Goodloue

David Bennett North Side of Chicago

Cayetano Silva Northwest Side of Chicago

Betty Jackson South Side of Chicago

Margaret Polovchak Northwest Suburb of Chicago

Donna Smith South Side of Chicago

Brian Tobola Southwest Side of Chicago

Sarah Iwema Northwest Suburb of Chicago

Ana Arroyo Southwest Side of Chicago

Linda Engeman South Cook County

If any of these people have the guts to contact me, they can do so at my e-mail address:

Dr Linda Shelton, who has devoted her life to service of others and particularly to providing medical and mental health services to the poor will be completely destroyed in two weeks with a false conviction for Illinois Medicaid Fraud simply for trying to help people on Medicaid obtain mental health care. Please read the following and help any way possible. I thank anyone who will help me.

This is a story epitomizing government corruption and greed, retaliation against whistle blowers, and gross government incompetence brought on by decades of fraud, patronage, and nepotism in Illinois.

Judge Jorge Alonso ruled on my pending criminal case where I am charged with Medicaid fraud that “substitute billing is illegal”. This is where a doctor sends a bill to the insurance company for services performed by his employee such as the service of a nurse administering a vaccine or a psychologist administering a psychological test, or a cast technician applying a cast. In my case the Illinois Attorney General claims that if a doctor bills Medicaid for counseling (for drug addiction, post-traumatic-stress disorder after rape, obsessive-compulsive disorder, depression, dementia, etc.) if the counseling or psychological testing was done by an employee and not directly by the physician then it is a felony crime.

If substitute, also known as incident to, billing is illegal than ALL doctors in Illinois are guilty of a felony crime of fraud! God Help Us! Judge Alonso is so eager to railroad me and convict me that he is violating his oath of office to uphold the laws of the land and the constitution. Due process, guaranteed by the Bill of Rights REQUIRES that he follow the law. He is BLATANTLY violating the law, either maliciously or ignorantly due to his arrogance, incompetence, bias to run and support the alleged prosecutor AG Lisa Madigan, or his ego.

Physicians are NOT trained to do psychological testing for personality disorders or mental illness. Psychologists at the master’s and Ph.D level are trained to do so. These tests are invaluable in helping determine the right diagnosis and the right course of treatment. Judge Alonso has ruled that those on Medicaid are not eligible for this type of evaluation and treatment as a result of his illegal and unconstitutional ruling.

Many non-physicians are licensed in Illinois and all states to provide Psychiatric & Psychological Services:

Judge Alonso’s illegal ruling denies all of these people the RIGHT to practice their profession and denies the citizens of Illinois on Medicaid the Right under the Federal Medicaid Act to access to care equivalent to the care provided in the community.

Federal Judge Joan Lefkow ruled in August 2004, at the end of a 12 year civil rights class action suit that “Illinois Medicaid Policies and Procedures are in Violation of the Federal Medicaid Code because they Deny Access to Care” to children on Medicaid. This ruling is applicable to all Medicaid patients but the ruling only applies to children. It needs to be expanded to cover all Medicaid patients.

The Federal Medicaid Code, 42 U.S.C. 1396A(a)(30)(A), [regarding adults and children covered under Medicaid and the EPSDT program] REQUIRES any State Medicaid program funded by the federal government to provide care equivalent to that obtainable from private insurers in the community to Illinois Medicaid clients.

Therefore, Judge Alonso’s ruling is unconstitutional, unfair, illegal, and amounts to his ruling to overturn the Federal Medicaid Code as well as Illinois Statutes licensing non-physician providers of mental health services. As > 80 % of mental health services are provided by non-physicians this essentially shuts out mental health services to all but a few in Illinois who are poor.

The Federal Court and U.S. Attorney should intervene as this is illegal and also a violation of the Americans with Disabilities Act in terms of discrimination.

As to my case, I am charged with billing for mental health services never done and substitute billing for mental health services between June 2000 and April 2002 while “working” at Right Frame of Mind & Associates (RFOM). Over the last six months when I obtained access to the old business records for RFOM I discovered the fact is that the year before I started working for a group practice called RFOM, part-time providing chart review for quality, consultation about medical and psychiatric policies and procedures, and limited patient care, two woman, who were partners with the CEO and without the knowledge of the CEO, in 2000 fabricated hundreds of patient encounter forms (filled out by doctors or therapists as to what patient they saw, the diagnosis, and what service was provided), that are later translated into bills or invoices by the billing agent, for services they never did. These two women, Itadel Shalabi and Nareman Taha never met me as they were fired before I started working there in 2001.

I had major neurosurgery in July 2000 due to a congenital spinal problem that was crushing my spinal cord and leading progressively towards quadraplegia. I was incapacitated for six months and heavily sedated with narcotics and other drugs for much of that time. I had agreed in early 2000 at the request of the CEO to be one of a dozen or more part-time medical directors to oversee quality of care, screen for medical disorders mimicking psychiatric disorders, help train the counselors to write better notes (many were foreigners with good counseling skills but a little difficulty with English writing), advise the CEO on best medical practices and standard of care, and provide physician services to patients needing medications.

I or my staff while I was in hospital gave the CEO my Medicaid provider number and other necessary documents so that the company’s billing agent Louise Moore of Data Medical Works could sign me up with Medicaid as a provider for the group so that they could bill for my services when I began to work, if I recovered, in 2001.

Ms. Moore I never met at the time was a sweet lady who is ignorant of a lot of things. She held herself out to be a expert at medical billing and she signed a contract with the CEO in early 2000 to set the group up legally to bill Medicaid. Nothing she did was actually proper, but it was not her own fault. She failed to tell the CEO he would be paid more if he had his group certified as a community mental health center. She was totally ignorant of the concept of community mental health centers (or the drug addiction and alcohol treatment centers – another center with its own enabling State Statue).

Under the Community Mental Health Service Act mental health groups that become certified bill Medicaid under the Center’s name and not under the doctor’s name. They also contract with the Illinois prisons, and/or DCFS (Illinois Child Welfare) or other agencies to provide comprehensive mental health services. They must have at least one medical director, but the director is an administrator and doesn’t have to see patients. Ph.D. psychologists or doctors or licensed mental health providers can supervise non-physician mental health service providers and bills can be sent in to Medicaid under the center’s name for all these services.

Ms. Moore ignorantly thinking (falsely) that her contract allowed her to sign the names of Right Frame of Mind employees on to any form signed my name in August and December 2000, without my or the CEO’s knowledge or consent, on a power of attorney form, an alternate payee form, and a blue cross/blue shielf electronic partner trading agreement form, which are all required to allow her to translate the patient encounter form to an electronic invoice and send it over the wire to BC/BS for adjudication, who then sends it to Medicaid, who then pays abut 30-40 cents on the dollar to the Alternate Payee (in this case RFOM).

Ms. Moore had spoken to the Medicaid Provider Service Unit about how to register the non-physician providers to bill Medicaid. She was told that non-physicians cannot bill Medicaid, was NOT told that a better way to bill was as a community mental health center or how to sign the group up as a community mental health center, and told that all bills (invoices) had to have a doctor’s name as the provider.

Then Ms. Moore, without my or the CEO’s knowledge changed the provider name in preparing invoices from Itadel Shalabi’s and Nareman Taha’s fraudulent patient encounter forms to my name so she could bill under my Medicaid Provider Number. I don’t believe that Ms. Moore had ANY knowledge of the fraudulent nature of the Patient Encounter Forms made by these two women.

Therefore the ghost billing charge is a result of ID Theft, resulting from both fraud by these two women and a comedy of errors by incompetent people advising Ms. Moore in the Medicaid Provider Service Unit, as well as her own blundering ignorance. I am totally innocent having not participated in any way in generating these bills or in receiving or using the money paid for them by Medicaid.

Ms Moore unfortunately is also guilty of mass fraud in all the work she has done in the past decade or more. It is illegal for an insurance biller to bill Medicaid based on a contract where they are paid by the percentage of funds received from Medicaid by the provider. Ms. Moore charged around 8% of all billings. This is illegal and considered fraud as it ties the billers service, which has nothing to do with the medical care provided, with the doctor’s service. Therefore, if she billed for a $100,000 procedure by a heart surgeon she would be paid $8,000 for sending in one bill, while when a family doctor bills $100, she would be paid $8. Providers of services to doctors are NOT ALLOWED to tie their services to the income from the actual medical provider. She MUST BILL ONLY by the piece of work such as $8 per bill. However, she has not been indicted for Medicaid Fraud and has not been sued by RFOM for Fraud in holding herself out to be an expert on billing when she was not.

The second aspect of the charge is substitute billing. I signed a Power of Attorney Form and Alternate Payee Agreement in August 2001. I was informed by the CEO sometime in late 2001 or early 2002 that the group was told by Ms. Moore that the counselors’ and psychologists’ services had to be billed under a doctor’s name so that bills on patients I had seen, but for dates of service when they were seen by a non-physician were being billed under my name. I had assumed that the billing agent was competent and doing the billing properly. I had assumed that substitute billing for employees services in mental health care was as legal as billing Medicaid for my nurse giving a patient a vaccine. I had no idea at the time that anyone considered substitute billing illegal. I had no knowledge that Ms. Moore had actually sent in tens of thousands of dollars worth of bills under my name before August 1, 2001 based on documents she forged and the fraudulent patient encounter forms from the above two women. Therefore, I told the CEO that was fine. I was not involved in billing or administration of the group except to fill out patient encounter forms when I saw a patient. I had a good faith belief that all was well.

I had also had an agreement that being part-time the business would limit my patient panel to 200 patients as I did not feel that part-time doctors should supervise the care of any more patients than this number.

Since Judge Alonso has unconstitutionally and illegally ruled that substitute billing is illegal I will be found guilty and likely sentence to prison for 4-15 years, as well as forever lose my medical license and reputation, along with my livelihood, future, friends, health as medical care is inadequate in prison and I am disabled with several serious medical disorders, and will to live. I have informed the U.S. Attorney, FBI, at the time Senator Obama, Senator Durbin, and now Senator Burris along with a lot of Congressmen and other Sentators and State legislators. I am receiving no assistance to solve this problem and restore mental health care in Illinois to those on Medicaid.

In late 2001 Ms. Lovett, Ms. Collins and others from the Office of Inspector General Medicaid contacted the RFOM and claimed that they needed to review some charts as a “standard review of a new practice to help us comply with the rules”. We completely complied and Ms. Lovett came out in 2001. She told the CEO the charts were well done and she would give us a report in 90 days. The CEO was actually very happy about this review because he wanted to make sure that our group practiced with the highest quality and had the best quality charting in the business. They never gave us a report or any feedback and their only response was to initiate a felony prosecution which culminated in the indictment of selectively me (and not one other of the dozen or so medical directors doing the same job – perhaps because only the CEO and I were whistle blowers about Illinois Governement Corruption and mistreatment of children in foster care and on Medicaid by the State) and the CEO.

After a number of months with NO feedback and strange comments from the Illinois State Police Medicaid Fraud Unit (part of the Illinois Attorney General’s Office), where the CEO had gone to inform them that he was concerned abut the integrity of our medical records because he had fired Itadel Shalabi and Nareman Taha for other administrative misconduct and inappropriate behavior with patients and they stole a hundred or so medical records (eventually returning parts of them) I began my own investigation of the rules of Medicaid. The State Police have not arrested them yet.

The CEO, I had learned over about a year was much more naive than I thought about running the business. I had assumed that he was qualified as an administrator and found out he was not. Finding out about the stolen charts and the lack of feedback from the OIG-Medicaid on this “routine review” concerned me. I was also concerned because in April 2002 the CEO told me that Ms. Collins at OIG-Medicaid had informed him to talk to Mr. Brown at Medicaid because there was a problem with the way our group was set up. Mr. Brown told the CEO that RFOM could not be a proper alternate payee under their rules and he apologized for misleading the CEO when the group was originally set up in 2000. He told the CEO that Medicaid could not continue to pay the group unless it was owned by the doctors. The group was the sole proprietorship of the CEO a master degreed psychologist. The CEO said OK, hired an attorney, and asked several of the doctors to be the officers of the group as it changed to corporate status. The corporation was set up so that the doctors would not actually profit from the corporation but were only paid by the hour for their work. The CEO was going to make a profit from managing the corporation. However, no profit was ever made as all the income went to overhead, particularly paying the counselors and doctors their salary and/or hourly rate. The CEO actually put in $100,000 of his own money to meet payroll before he closed the business as no viable financially. My total income from the group was about $5000 over all the time I worked there from 2001 to 2003. I always told the CEO to pay the other employees first and my work was only very limited and part-time.

Beginning in 2002, I researched the Federal and State Medicaid rules, policies, and laws so that I would be able to meet my fiduciary duty to participate in running the corporation at least from an advisory point of view. I discovered the following and this is why I told the CEO in mid 2002 and maintain this belief, that substitute billing is perfectly legal and actually REQUIRED by the Federal Medicaid Code as well as NOT PROHIBITED by Illiniois Statutes or Illinois Adminstrative Rules:

Federal and State Medicaid laws are extensive, complex, and immensely confusing. The State of Illinois is misusing them to indict doctors, psychologists, administrators of psychiatric and psychological practices for “Medicaid Fraud” when they are actually following federal law and providing needy services including counseling, drug treatment, suicide prevention, etc. Attorney General Lisa Madigan and Jim Ryan before her have targeted especially those groups run by whistle blowers, in order to falsely claim they are tough on fraud, to prevent Illinois from paying the bill for mental health services for the poor and needy on Medicaid, and reduce the bottom line.

A claim of “tough on fraud” will help AG Lisa Madigan win election as Governor. Failure to provide mental health care including drug addiction and alcoholism treatment leads to increased crime as drug addicts, alcoholics, and those that are so out of touch and mentally ill find alternatives to legitimate work to feed their habits or survive. Failure to provide adequate mental health care at the front end leads to much higher costs in the long run.

Code of Federal Regulations 42 CFR 414.34 states:
“Payment for services and supplies incident to a physician’s service”
“(b) Services of non[-]physicians that are incident to a physician’s service. Services of non physicians that are covered as incident to a physician’s service are paid as if the physician had personally furnished the service. ”

United States Code42 U.S.C. § 1396d(a)(5)(A)requires reimbursement for “physicians’ services furnished by a physician.”

Code of Federal Regulations 42 C.F.R. § 440.50The HHS rule implementing the Medicaid Act defines “physician services” to include services provided:
“(a) within the scope of practice of medicine or osteopathy as defined by State law; and
(b) by or under the personal supervision of an individual licensed under State law to practice medicine or osteopathy.”

United States Code42 U.S.C. §1396a(a)(32)(C)
Congress further authorized substitute billing under Medicaid for services furnished:
“by, or incident to the services” of another physician

Federal Regulation66 Fed. Reg. 55268
HHS makes clear in its preamble to this rule that it does not restrict the type of auxiliary personnel who may perform a given “incident to” service: “We deliberately used the term any individual so that the physician (or other practitioner), under his or her discretion and license, may use the service of anyone ranging from another physician to a medical assistant.”

FEDERAL PREEMPTION SUSTAINED BY FEDERAL 2ND CIRCUIT COURT OF APPEAL
•A Federal suit for a psychiatrist against the New York Medicaid Program based on its refusal to approve Medicaid was agreed to for reimbursement for services provided by his employees under his supervision. Yapalater v. Bates, 494 F. Supp. 1349 (S.D.N.Y. 1980), aff’d, 644 F.2d 131 (2d Cir. 1981), cert. denied, 455 U.S. 908, 102 S. Ct. 1255 (1982).
•The court determined that the federal Medicaid rule at 42 C.F.R. §440.50 defining “physician services” unquestionably included supervisees other than the physician, just as the same rule must apply here to vacate Plaintiffs’ indictments. Id. at 1363-64.

State Medicaid must Provide Services 42 U.S.C. 1396a(a)30(A)•Federal Code clearly mandates that State Medicaid plans must provide services to recipients of Medicaid and payment to their service providers equivalent to care and services provided to the general population by private insurers
•Private insurance pays for psychiatric services provided by counselors and psychologists
•RFOM CEO and other employees, besides the physicians were licensed counselors, nurses, psychological therapist, or social workers, per CEO

42 U.S.C. 1396a(a)30(A)“A State plan for medical assistance must –Provide such methods and procedures relating to the utilization of, and the payment for, care and services available under the plan . . . to assure that payments are … sufficient to enlist enough providers so that care and services are available under the plan … at least to the extent that such care and services are available to the general population in the geographic area“,

I (SHELTON) CONTINUES HER OWN INVESTIGATION OF BILLING PRACTICES – 2002-2005

•Shelton discovers that Physician Medicaid Manual has inconsistencies, in one place stating bills for employees billed under doctor’s name, and in another place stating that no psychiatric services can be billed for non-physicians, yet in another place stating that non-physicians may provide psychiatric services and Medicaid may be billed. She also discovered the Illinois Community Mental Health Center Code.

Illinois Administrative Code
89 IAC 140.400(a)“Payment to Practitioners”
“2) A practitioner may bill only for services he or she personally provides or which are provided under his or her direct supervision in his or her office by his or her staff.”

Illinois Administrative Code
89 IAC 140.411
“Covered Services by Physicians”
“The Department shall pay physicians for the provision of services not otherwise excluded which are:
. . .
c) Provided by the physician or by a member of the physician’s staff under the physician’s direct supervision

Illinois Administrative Code
89 IAC 140.413
“Limitations on Physician Services”
that “limitations” on physician’s services include that psychiatric services will be paid for if they are “. . . provided by a physician . . .” [It does not exclude non-physician services and it is a reasonable inference to conclude the definition of “physician” include the services of non-physician employees, under the doctor’s supervision as defined in 89 IAC 140.400 & 411]

How does this negate previous definition of “physician services” which include incident services by his employees?

UNCONSTITUTIONAL STATE CLAIM
State falsely claims use of word “physician” in 89 IAC 140.413 negates definition of
“physician services”, which includes incident services by physician’s employees as defined in 89 IAC 140.400(a), 89 IAC 140.411

State falsely claims that federal law does not apply and statutory construction rules don’t apply
Judge Alonso previously illegally ruled that the Federal Medicaid Code does not apply in this case despite the fact the Illinois Medicaid is a joint federal/state program partially funded by the Federal Medicaid Code!

STATUTORY CONSTRUCTION RULES REQUIRE (Regarding interpretation of conflictin State Statutes)
Specific Controls over General
•89 IAC 140.400 & 89 IAC 140.411
more specific “physician services” includes non-physician employee services
•89 IAC 140.413 general word “physician” with no definition of what services this includes cannot by exclusion negate previous more specific definition of services provided by physician

Federal Law Rules
42 CFR 414.34
Services by Physician’s staff are billed as IF the Physician Performed the Services Himself

If State and Federal Law conflicts, Federal Law RulesDue to the Supremacy Clause of the United States Constitution

FEDERAL LAW REQUIRES PAYMENT FOR EPSDT SERVICES
•The Federal Medicaid Code requires that State Medicaid programs pay for periodic mental health screening and treatment of any defects in mental health for children under 21:
• 42 USC 1396d “Definitions For purposes of this chapter
• (r) Early and periodic screening, diagnostic, and treatment services
•
•The term ‘early and periodic screening, diagnostic, and treatment services’ means the following items and services:
• (1) Screening services –
• (A) which are provided –
•(ii) at such other intervals, indicated as medically necessary, to determine the existence of certain physical and mental illnesses or conditions;
• . . .
•(5) Such other necessary health care, diagnostic services, treatment, and other measures described in subsection (a) of this section to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan.”

STATE LAW REQUIRES PAYMENT FOR EPSDT SERVICES•89 IAC 140.485 states:
•“Healthy Kids Program
•Program Description
–The Healthy Kids Program is the Early and Periodic Screening Diagnostic and Treatment Program [EPSDT] mandated by the Social Security Act (see 42 U.S.C. 1396a(43), 1396d(4)(B)(Supp. 1987)). The goals of the program are to:
•Improve the health status of Medicaid-eligible children ages birth through 20 years through the provision of preventive medical care and early diagnosis and treatment of conditions threatening the child’s health
•…
•8) Treatment. The Department shall pay for necessary medical care (see Section 140.2), diagnostic services [i.e. psychological testing], treatment or other measures medically necessary … to correct or ameliorate defects, physical or mental illnesses….”,
•The Illinois Public Aid Code [AKA Medicaid Act], 305 ILCS 5/19(f) requires that EPSDT screening and mental health treatment be provided to children in the Medicaid program:
•“5/19. Healthy Kids Program
•(f) Covered Medical Services. The Illinois Department shall provide coverage for all necessary health care, diagnostic services, treatment and other measures to correct or ameliorate defects, physical and mental illnesses, and conditions whether discovered by screening services or not for all children eligible for Medical Assistance under Article V of this Code.”

Dr Shelton was a Medicaid Registered EPSTD Provider

Therefore ANY REASONABLE person would conclude that the law permits substitute billing for mental health services whether it be another physician covering for the doctor, or a non-physician supervised by the doctor or her colleagues. If you don’t agree than the void for vagueness doctrine should clearly negate and prevent any criminal charges for substitute billing.

God Help Me! I am innocent and destroyed. This is my reward for devoting my life to service particularly of the poor and needy. If you want to help, contact the Illinois Reform Committee and flood them with letters. Contact the U.S. Attorney and FBI and flood them with letters. Contact your legislators and Congressmen and flood them with letters. Come to the trial on February 17, 2009 which will last two weeks and fill the gallery so that the judge knows your opinion. Contact the press. Donate to my legal fund anything possible. I need tens of thousands of dollars. Shelton Legal Fund, C/O Albukerk & Associates, 3025 W. 26th St. 2nd Floor, Chicago, IL 60623. Thank you if you help.

I am aware that my opinion on this topic may be controversial, however I still want to point out an aspect of the conviction that is not being discussed. It is a basic principle of criminal law that even if a person is guilty they are entitled to certain procedural and legal rights. The U.S. Supreme Court has thrown out murder convictions when the Bill of Rights has been violated, because honoring and preserving the Bill of Rights is more important than an individual.

It is impossible for me to give an informed opinion about the conviction and sentencing of Mr. O.J. Simpson for theft of sports memorabelia because I have not seen or heard the evidence completely, so it is unfair to even try to give an answer. Perhaps it is even inappropriate to comment. However, I am commenting because of what I perceive to be a serious violation of the Bill of Rights and because the hatred I hear towards him makes me puke. There is no place for emotion in sentencing by a judge. The fact that the judge who sentenced him stated that she did not consider the murder trial, simply means to me she did consider it. It is a simple fact in psychology that drunks and addicts deny their additions more vociferously than the sober. This judge is no different than the addicts in her denial.

Anyone who says this is pay-back for his acquittal on the murder charge is violating the essential principles of our Constitution and should be ashamed of themselves as they have committed treason in their statements in my viewpoint. Nothing is as important as preserving our Constitution in terms of preserving justice in the future. If we trash it and its principles we trash America and our future. If we violate our basic principles of law with Mr. Simpson, then this opens the door to violate law in every criminal trial.

What I did hear is that Mr. Simpson did not have the mens rea (criminal intent). He clearly stated he was trying to collect his “stolen” property. He had been pushed to the brink of mental delirium on this point as he had been through a very intense murder trial and then very intense civil trial where he was forced to pay 33 million dollars, as well as constantly hounded by the debt collectors. It appeared he simply cracked – with the help of others pushing him. He was so focused on trying to keep some of his property that had meaning like a wedding ring for first marriage and other things that were important to his self-esteem and family that he was not at times rational – apparently believing the property still belonged to him. He clearly loves his children and has for years been trying to hold on to what he could to pay for things for his family.

It is a basic principle of criminal law that when a person does not have the mens rea in an intent crime, which is what he is charged with, he is not guilty. I would say he is not guilty by reason of insanity. He perhaps should have been convicted of a lesser included offense such as misdemeanor trespass that does not include mens rea. However, if the property really did not belong to him anymore and he was aware of this, than he is an accessory to armed robbery even if he did not hold the gun. To me, kidnapping is a real stretch. He clearly should have had an in depth evaluation by a psychiatrist. I believe the sentence is far greater than the true offense and should be no more than 1 year, or at least 1 year in a mental institution. He should be forced to undergo mental health evaluation and counseling for an extended period of time.

I would welcome comments that educate me about the law in this case. If I am wrong in my interpretation, I would appreciate comments.